Advance healthcare directive for healthcare professionals and Designated Healthcare Professionals

James, a middle-aged man with Down syndrome living in a supported care facility, is diagnosed with a brain tumour. With the support of his parents, James makes an advance healthcare directive to govern his future care for the brain tumour if he lacks capacity to make healthcare treatment decisions. He appoints his mother as designated healthcare representative.

James discusses his advance healthcare directive with his key worker, but she expresses quite different views about what his treatment should be. James speaks to his parents about the disagreement, telling them that his key worker said she did not know if they could keep him in the supported care facility unless he agreed with their plans for his care. This upsets James greatly as he fears he will become homeless.

James and his parents arrange a meeting with the key worker at which they explain the pressure he feels to alter his advance healthcare directive. His key worker apologises immediately as she had not realised that she was exerting so much pressure on him. James continues with his unaltered advance healthcare directive.

Comment: This vignette illustrates that fraud, coercion, or undue influence (which may be unintentional) should not be used to force someone to make, alter, or revoke an advance healthcare directive.